Version 1
–June 2014.
Coverholder Name
PIN
Domicile
Date application submitted
Broker
Managing agent
Type of authority
Classes
Enter coverholder legal name
Enter PIN
Enter domicile of coverholder
Enter date application submitted to Lloyd’s
Enter full broker name. If no broker, enter N/A
Syndicate
Enter syndicate no
Enter full managing agent name Lead line size (%)
Enter % lead line size
Enter the level of authority being requested
Currency &
EPI
Enter the total EPI to
Lloyd’s
Enter generic classes being requested and risk codes
Lloyd’s Assistant/Executive LLOYD’S USE ONLY
CRS checks & Email to Reg Liaison
Reps report sent
Undertaking received & filed in G:drive
MED Apps tab filled in
Stage 1 complete
Date to SUP
Stage 2 complete
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LLOYD’S USE ONLY UP referral required (Y/N) & reason
Initial rating for LOS
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LLOYD’S USE ONLY Initial rating for App
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This document is intended to be from the managing a gent’s perspective, a wrap up of your views on how this prospective coverholder fits into your business plan and portfolio. It should be treated as a confidential document between managing agent and Ll oyd’s.
Overview of Application - summary
We expect this section to contain the following information:

A summary of the applicant – any material information that you think is relevant to the application.

Rationale from the underwriter as to why they are happy to sponsor this application.
If this is not existing business then also provide the following information:

The background and nature / length of the relationship. This should include your familiarity with the key people concerned and their capabilities, and whether the managing agent has written their business on an open market basis previously.
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The classes of business, including a description of the type of risk to be written, risk codes proposed and corresponding E.P.I
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Rationale for the binding authority; from both the managing agent’s and the applicant's perspectives
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Details of risk/agg limits and information on pricing of risks
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Extent of underwriting authority to be delegated (prior submit, pre-determined rates no discretion, predetermined rates, full authority). If full authority please give a detailed rationale.
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A description of the current market conditions

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Prior year results and forecast results
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The extent of any claims authority proposed, the parties involved in the claim chain and their roles/authorities, and how these parties will be audited.
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Outcome of any pre-approval underwriting and claims audit or visits (including audits carried out on behalf of other managing agents of the same coverholder/claims administrator)

Whether the proposed insurance documents and bordereaux and any marketing/website material have been vetted/approved by yourselves and are in line with Lloyd’s expectations
Outstanding issues
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Application Review Stage 2
This section is to provide your statements that you, as the managing agent, have reviewed all the points raised and give your evidence of this. Your response should replace the guidance.
Company Information
State where BRANCH IS LOCATED and that you have engaged with the
Country Manager (if rep located in this territory)
Is this branch in the same country/state/province as the head office?
If NO please attach the correct licenses to ATLAS.
Underwriting and Claims
State here if the branch will have the same underwriting authority level?
If different authority from head office provide a rationale for this.
Claims
State here if the branch will have the same claims handling arrangements?
If no, state who will be handling claims.
If TPA then confirm you have a separate TPA agreement in place and they are on the Lloyd’s approved TPA list.
State the following if this location is applying for claims authority:

The level of authority that the applicant will have.

If the applicant has a claims handling limit – what is the limit? Who will handle claims after this limit?
 Which staff listed under the ‘key staff’ section has the relevant experience to administer the proposed claims function?

Is there a segregation of duties?

The procedures for sanction checking prior to claims payment
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Please provide a copy of the claims agreement.
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Are you aware of this applicant ever having claims authority under a binder cancelled by underwriters?
Principal Staff & Reputation
List each key staff here and confirm the following:

Are any of the key staff the same from the approved offices?
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Is the coverholder requesting claims authority? If so, state which key staff will be handling claims? If the applicant is not applying for claims
Outcome
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authority, then they should not have any individuals ticked as having responsibility for claims – confirm this is correctly showing on Atlas.

State here if any of the key staff are remote workers.
If only one key staff member listed state what would happen in the event this person is suddenly unable to work.
Reputation & Standing:
 State your awareness of any declarations under the ‘Reputation &
Standing’ section. If any declarations made, please provide details around these, including the rationale why the Managing agent is happy with this issue. If none state “No reputational self disclosure”

State whether the applicant has ever had a binding authority nonrenewed or terminated.
If so please give your understanding of why this happened
Class of business
State here if the business will be written under an existing binder and
EPI?
If NO state the following:
Which classes are different and attach a business plan.
State you have checked the risk code mapping document and the correct classes have been requested on Atlas. If classes differ please explain the reasons behind this.
Lloyd’s DAT will assess whether the application requires referral to Syndicate
Underwriting Performance and will follow up on any queries they have.
Give a statement here to say that you have satisfied yourselves that the
Coverholder is aware of all the regulatory and tax obligations it has for the territories in which it is doing business. List any specifics for each territory and how these have been addressed.
Regions
Does this branch cover the same regions as the already approved office?
For other licensed and non licensed state which specific territories this is for.
For other regions we request additional information, i.e. for Canada, we expect a signed copy of the Canadian Questionnaire from the applicant to be submitted with the application.
For details of all the information we require for each region check the following link http://www.lloyds.com/the-market/i-am-a/delegatedauthority/changing-coverholder-details
Systems & Bank Accounts
Does the branch office operate off the same systems and link into the already approved office?
If no, please state the system used.
Are the management policies, processes, procedures and oversight regime the same as the already approved office? Including complaints
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and financial crime policies?
Are existing bank accounts used?
If not provide details, including account signatories, and assurances that they are not sweep accou nts and meet Lloyd’s standards.
Professional Indemnity
State here if the E&O Policy for the already approved office covers this branch office?
Is the current PI cert/policy uploaded to the head office on Atlas?
If not provide the updated policy and confirm when this will be uploaded to
Atlas.
Does it state it that includes binding authority activities in its coverage?
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Specific Information Rationale
Classes and codes specified Facilitates precision and correct coding on Atlas
GPW per class
Description of risks to be written
Risk/ Aggregate Limits
Important to get COB split and view against syndicate
SBF. Confirm SBF spreadsheet checked.
Helps understand target business profile/risks
Per risk/event and Agg limits help assess overall review
Received
Y/N
Info on pricing of risks
Info on market conditions
Rationale for selecting Lloyd's
Prior year result data
Info on forecast results
Relevant experience of personnel
Extent of delegation
Critical Lloyd's understands basis of pricing and terms
Assists our understanding of local market issues
Useful information on local market and Lloyd's positioning
Insight into profitability performance to date
Managing agent forecast of future loss ratios by year
Underwriting capabilities of coverholder key staff
Lead syndicate proposed line
Describe claims handling
Policy/Cert wording agreed
Whether full, pre determined or prior submit
Critical to understand limit assumed by lead
Any delegation to coverholder/TPA and limits applicable
Contract certainty requirement prior to inception
Bordereau format (ACORD etc) Check on whether in line with Lloyd's expectations
If a Service Company check that they are compliant with control framework phase I
Control Framework Phase II
Requirement of Control framework project
The managing agent must give a statement to say that they have satisfied themselves that the Coverholder is aware of all the regulatory and tax obligations it has for the territories in which it is doing business. List any specifics for each territory and how these have been addressed. The use of Crystal Assist tests are advocated for all Coverholders writing multi territories.
Time with MA/Broker LLOYD’S USE ONLY Time with DAT LLOYD’S USE ONLY
Approval
Managing Agent Please sign here Date Add date of sign off

Peer (DAT executive)
Manager
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Date
Date
Please ensure you send a pdf version with the Managing agent sign off and also a word version to coverholders@lloyds.com